Through a series of steps small and large, the Johns Hopkins University Department of Medicine appears to have made major advances in five years to reverse decades of poor results in retaining and promoting female faculty members.

The department, the university's largest, was able to change course without involving "set asides" or quotas, according to a report published today in the Journal of the American Medical Association.

The study's authors said the gains resulted from moves to ensure that women were treated more fairly and generally felt welcomed by the traditionally male department.

From 1990 to 1995, there was a 550 percent increase in women at the associate professor rank, and strong increases in the percentage of women who expected to stay in academic medicine.

Male professors, increasingly part of a national trend toward two-career marriages, also appeared to make gains, primarily because all faculty members were better able to balance family life and career demands.

"Our goal is to help people work smarter, not work longer," said Dr. John D. Stobo, chairman of the department from 1985 to 1994, who started in 1990 the campaign to bolster the position of female professors, a need generally common at U.S. medical schools.

A 1989 university-wide panel found disparities in pay and promotion rates between men and women. Aided by several colleagues, Stobo commissioned a survey of the department's climate for women.

Two-thirds of the department's nearly 200 full-time faculty members responded, and the results roused him from complacency, he said.

"If this department is going to attract and retain the best faculty, it had to make sure this environment is supportive" of women as well as men, Stobo said yesterday.

No sacrifice in quality

Some internal critics argued that the changes would dilute the commitment of faculty members to their field, Stobo and others said. Yet administrators say positive results occurred without any change in the quality of research or clinical care.

Statistics offer a glimpse of the results described in the JAMA article:

In 1990, only 23 percent of women surveyed said they expected to be in academic medicine 10 years later, less than half the level of men who did.

In 1993, 65 percent of women expected to stay in the field. The proportion of female medical professors who were seriously considering leaving academic medicine dropped from 63 percent to 28 percent in the same three years.

And in 1993, 73 percent of female professors said they expected to be promoted, up from 44 percent in 1990.

Their faith appears to have been justified: There were 50 percent more senior female faculty after three years and 550 percent more associate professors (the second most senior rank) after five years.

Today's JAMA article, written by Stobo and eight colleagues, most with Hopkins connections, said the 1990 survey had indicated that women felt they were not adequately encouraged by faculty mentors.

As a result, medical professors were asked to involve female colleagues more as leaders in presentations, lectures and research.

There were some fundamental equity issues addressed, such as raising the base pay of women who did not earn as much as their male peers with the same experience.

Rigid schedule eased

The rigid schedule under which physicians are reviewed for promotion was eased slightly for all professors. And women were added to departmental committees that lacked them.

Just as important, said Dr. Linda P. Fried, one of the article's co-authors, were some relatively modest shifts with important symbolism.

The traditional ethic at Hopkins and other academic research schools is to demand a monk-like devotion to work, administrators and faculty members said.

Weekends, evenings, holidays, have all typically been seen as good chances to catch up on research, scholars said. That changed under the Stobo regime.

For example, grand rounds, the Hopkins tradition of 8 a.m. Saturday morning lectures by medical faculty members to their colleagues, stretched back a century. That was switched to Fridays.

Departmental meetings also were shifted from evenings and weekends to normal working hours on weekdays. And attendance at both climbed sharply, doctors said, giving younger physicians with children more chance to take part in the life of the department.

The changes may appear minor. But because household duties still fall disproportionately on mothers, the changes particularly helped female professors minimize conflict with family obligations. And men also said they appreciated the ability to spend Saturday mornings at home without missing departmental matters.

Parity is distant goal

Parity remains a distant goal: In 1995, 64 women held tenured or tenure-track, full-time positions, up from 45 five years before. Men held 223 such positions in 1995, a rise from 187 in 1990, according to the article.

That means women in 1995 made up 22 percent of all faculty members in the Hopkins Medicine Department, a 3 percent rise from five years before.

But, said Dr. Laura Mumford, a faculty member at Hopkins from 1984 to 1994 who was not prominently involved in the initiative: "This was a sincere effort, not just for show. It's really very basic."

Several outside observers also praised the multipronged approach adopted by Hopkins.

"It's clear to everyone that there is no magic bullet," said Shirley Tilghman, a professor of molecular biology at Princeton University who has lectured widely on the status of female researchers. "To quote Arthur Miller, 'Attention must be paid.' It sounds like that's what is at the core of what's going on at Hopkins."